The renin-angiotensin-aldosterone system is a key therapeutic target in hypertension. The latest meta-analysis of mortality reduction with angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) in hypertension features 158,998 patients from 20 contemporary hypertension trials. ACE inhibitors and ARBs significantly reduced relative risk for all-cause mortality by 5% (p = 0.032) and cardiovascular mortality by 7% (p = 0.018) in populations with a high prevalence of hypertension (≥66%). ACE inhibitors produced a 10% reduction in relative risk for all-cause mortality (p = 0.004) and a trend toward a 12% reduction in cardiovascular mortality (p = 0.051), whereas ARBs had no effect. On balance, mortality evidence suggests that in hypertension, ACE inhibitors should be considered ahead of ARBs, and ARBs restricted to patients intolerant of ACE inhibitors.

Additional Metadata
Keywords ACE inhibitor, all-cause mortality, angiotensin II, ARB, bradykinin, cardiovascular mortality, hypertension, meta-analysis
Persistent URL dx.doi.org/10.1586/erc.13.42, hdl.handle.net/1765/70436
Journal Expert Review of Cardiovascular Therapy
Citation
Ferrari, R, & Boersma, H. (2013). The impact of ACE inhibition on all-cause and cardiovascular mortality in contemporary hypertension trials: A review. Expert Review of Cardiovascular Therapy (Vol. 11, pp. 705–717). doi:10.1586/erc.13.42